• Raphaël Cinotti, Noémie Besnard, Luc Desmedt, FlochRonan LeRLAnesthesia and Critical Care, University Hospital of Nantes, Hôtel Dieu, 1 place Alexis Ricordeau, Nantes 44093, France., Pierre Perrot, Farid Bekara, Kada Klouche, Romaric Larcher, Pierre-Joachim Mahé, Denis Frasca, Karim Asehnoune, Boris Jung, and Antoine Roquilly.
• Department of Anesthesia and Critical Care, Hôpital Guillaume et René Laennec, University Hospital of Nantes, Boulevard Jacques Monod, Saint-Herblain 44800, France. Electronic address: raphael.cinotti@chu-nantes.fr.
• Burns. 2020 Sep 1; 46 (6): 1310-1317.

BackgroundSevere burn patients undergo prolonged administration of sedatives and analgesics for burn care. There are currently no guidelines for the dose adaptation of sedation-analgesia in severe burn patients.MethodsWe performed a before-after 2-center study to demonstrate the feasibility and efficacy of a sedation-analgesia scale-based protocol in severely burned patients receiving ≥24h of invasive mechanical ventilation. Before the intervention, continuous infusion of hypnotic and morphine derivatives was continued. During the Intervention phase, general anesthesia was relayed from day 1 by RASS/BPS-titrated continuous infusion of hypnotic and morphine derivatives and with short half-life drugs adminstered for daily burn dressings. The primary outcome was the duration of invasive mechanical ventilation in the ICU.ResultsEighty-seven (46.2%) patients were included in the Control phase and 101 (53.7%) in the Intervention phase. The median burned cutaneous surface was 20% [11%-38%] and median ABSI was 7 [5-9]. The durations of hypnotic and opioid infusions were not statistically different between the 2 phases (8 days [2-24] vs. 6 days [2-17] (P=0.3) and 17 days [4-32] vs. 8 days [3-23] (P=0.06), respectively). The duration of mechanical ventilation was 14 days [3-29] in the Control phase and 7 days [2-24] in the Intervention phase (P=0.7). When taking into account the competition between mortality and weaning from mechanical ventilation, we found no significant difference between the 2 phases (Gray test, P=0.4). The time-series analysis showed no difference for the duration of mechanical ventilation in the Intervention phase (P=0.6). Eighteen (20.7%) patients died in the Control phase, and 18 (18%) in the Intervention phase (P=0.6).ConclusionScale-based lightening of continuous sedation-analgesia with repeated short general anesthesia for dressing is feasible in severe burn patients but failed to demonstrate a decrease in the duration of invasive mechanical ventilation.Copyright © 2020 Elsevier Ltd and ISBI. All rights reserved.

47 keywords...

hide…